Provider Demographics
NPI:1083787055
Name:EKBAL H. ELKADRY, D.M.D., P.C.
Entity Type:Organization
Organization Name:EKBAL H. ELKADRY, D.M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EKBAL
Authorized Official - Middle Name:H
Authorized Official - Last Name:ELKADRY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-472-3919
Mailing Address - Street 1:1372 HANCOCK ST
Mailing Address - Street 2:UNIT #101
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-5107
Mailing Address - Country:US
Mailing Address - Phone:617-472-3919
Mailing Address - Fax:617-770-2329
Practice Address - Street 1:1372 HANCOCK ST
Practice Address - Street 2:UNIT #101
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-5107
Practice Address - Country:US
Practice Address - Phone:617-472-3919
Practice Address - Fax:617-770-2329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
Not Answered1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Not Answered1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
Not Answered1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAX11370OtherBLUE CROSS & BLUE SHEILD
MA9719091Medicaid